There is increasing evidence that access to critical care services is not equitable. We aimed to investigate whether location of residence in Scotland impacts on the risk of admission to an Intensive Care Unit and on outcomes.
This was a population-based Bayesian spatial analysis of adult patients admitted to Intensive Care Units in Scotland between January 2011 and December 2015. We used a Besag-York-Mollié model that allows us to make direct probabilistic comparisons between areas regarding risk of admission to Intensive Care Units and on outcomes.
A total of 17,596 patients were included. The five-year age- and sex-standardised admission rate was 352 per 100,000 residents. There was a cluster of Council Areas in the North-East of the country which had lower adjusted admission rates than the Scottish average. Midlothian, in South East Scotland had higher spatially adjusted admission rates than the Scottish average. There was no evidence of geographical variation in mortality.
Access to critical care services in Scotland varies with location of residence. Possible reasons include differential co-morbidity burden, service provision and access to critical care services. In contrast, the probability of surviving an Intensive Care Unit admission, if admitted, does not show geographical variation.
Access to critical care services in Scotland varies with location of residence. Possible reasons include differential co-morbidity burden, service provision and access to critical care services. In contrast, the probability of surviving an Intensive Care Unit admission, if admitted, does not show geographical variation.Delirium is a common complication of critical illness with a significant impact on patient morbidity and mortality. The Greater Manchester Critical Care Network established the Delirium Reduction Working Group in 2015. This article describes a region-wide delirium improvement project launched by that group.
Multiple Plan-Do-Study-Act cycles were undertaken. Cycle 1 April 2015 demonstrated only 48% of patients had a formal delirium screen. Following this a network-wide event took place and the Delirium Standards for the Greater Manchester Critical Care Network were produced. Cycle 2 May 2016 quarterly audits across the network monitored compliance against the agreed standards. Group events involved implementation of a delirium care bundle, sharing best practice, educating staff and providing guidance on the management of delirium. Cycle 3 November 2016 quarterly audit continued and a regional delirium study day was rolled out across the region.
We have 14 different units across our network, all of which have participated in the audit. The first audit showed a delirium point prevalence of 28%, subsequent point prevalence audits demonstrated rates as low as 13%. There has also been an improvement in the use of delirium screening tools. In the first audit 37% of patients had two delirium screens in 24?h, this has increased to 60% in the latest audit. Improvements were also made in availability of sensory aids and pain assessments.
The project has demonstrated the feasibility of delivering a coordinated delirium improvement project across multiple critical care units.
The project has demonstrated the feasibility of delivering a coordinated delirium improvement project across multiple critical care units.Intrapulmonary percussive ventilation is used in various clinical settings to promote secretion clearance, reverse or treat atelectasis and improve gas exchange. Despite a few studies reporting the use of intrapulmonary percussive ventilation in critical care, the available data remain insufficient, contributing to weaker evidence toward its effectiveness. Also, there is a paucity of studies evaluating the safety and feasibility of intrapulmonary percussive ventilation application in critical care. This retrospective pilot study has evaluated the safety and feasibility of intrapulmonary percussive ventilation intervention in non-intubated patients admitted to an intensive care unit.
The medical records of 35 subjects were reviewed, including 22 subjects who received intrapulmonary percussive ventilation intervention and 13 subjects matched for age, sex, and primary diagnosis who received chest physiotherapy. The records were audited for feasibility, safety, changes in oxygen saturation, chest X-ray changes, and intensive care unit length of stay.
A total of 104 treatment sessions (IPV 65 and CPT 39) were delivered to subjects admitted with a range of respiratory conditions in critical care. Subjects completed 97% of IPV sessions. No major adverse events were reported with intrapulmonary percussive ventilation intervention. Intensive care unit length of stay in the intrapulmonary percussive ventilation group was 9.6?±?6 days, and in the CPT group, it was 11?±?9 days (?=?0.59). Peripheral oxygen saturation pre to post intervention was 92%?±?4 to 96%?±?4 in IPV group and 95%?±?4 to 95%?±?3 in the CPT group.
Application of intrapulmonary percussive ventilation intervention was feasible and safe in non-ventilated adult patients in critical care.
Application of intrapulmonary percussive ventilation intervention was feasible and safe in non-ventilated adult patients in critical care.Acute kidney injury demonstrates a high incidence in critically ill populations, with many requiring renal replacement therapy. https://www.selleckchem.com/products/repsox.html Patients may be at increased risk of acute kidney injury if prescribed certain potentially nephrotoxic medications. We aimed to evaluate this association in ICU survivors.
Study design - secondary analysis of national cohort of ICU survivors to hospital discharge linked to Scottish healthcare datasets. Outcomes primary - renal replacement therapy in ICU; secondary - early acute kidney injury (calculated using urine output and relative change from estimated baseline serum creatinine within first 24?h of ICU admission using modified-RIFLE criteria). Primary exposure pre-admission community prescribing of at least one potential nephrotoxin angiotensin-converting-enzyme inhibitors/angiotensin-receptor blockers, diuretics or nonsteroidal anti-inflammatory drugs. Statistical analyses unadjusted associations - univariable logistic regression; confounder adjusted multivariable logistic regression.